Major bowel surgery

Colorectal Unit

How should I prepare myself before a major bowel operation?

If you are waiting to come in for a major bowel operation, it is important that you try to prepare yourself physically. If you are able to, try to eat a well-balanced diet including meat, fruit and vegetables. Take gentle exercise (such as walking) and get plenty of fresh air. If you smoke, do try and to stop before you come into hospital.

If you are on the contraceptive pill, you must stop taking it and take other precautions instead.

Who are the specialist nurses in stoma care?

If there is a possibility (or it is definite) that you will require a stoma (an ileostomy or colostomy) following your surgery, you will be seen by the specialist nurses in stoma care before and after your operation. These are qualified nurses who also have had specialised training in this field. They will see you on the ward before your surgery, and will co-ordinate your care afterwards. You will be visited by them when you first go home, and will be given their contact number at Addenbrooke's so that you can ring them for advice or help in the future. They are available to give you and your family support and practical help for as long as you need it (Cambridge Colorectal Team).

What should I expect to happen before a major bowel operation?

At Addenbrooke's, you will be admitted one to two days before your operation, so that we can assess you and prepare your bowel (cleanse it) by giving you powerful laxative drinks. You will not be allowed to eat during this time. You will only be allowed to drink clear fluids: water, black tea and coffee. Six hours before your operation, you will not be allowed anything at all to eat or drink.

What should I expect to happen after a major bowel operation?

When you return to the ward immediately after your operation, you will be attached to several tubes. During the actual operation, when the bowel is being handled, it stops working; for this reason, if we allowed you to eat and drink immediately after the operation, you would be sick. For a few days, you will, therefore, only be allowed sips of water to drink until we are sure the bowel is working again. While you are unable to drink properly, you will have a drip in your arm (or neck) to give you the fluids you require. You might have a tube in your nose, which goes down the back of your throat into your stomach, and prevents nausea and vomiting. You will have a catheter in your bladder to drain urine away. This allows us to monitor the amount of urine you pass, and means that you do not have to get out of bed to go to the toilet. These tubes are all put in while you are under the anaesthetic and will be removed over a period of days after the operation.

Should I expect to be in pain after major bowel surgery?

All aspects of pain control will be discussed with you when you come into hospital. You will naturally be sore from the operation, and everything possible will be done to reduce any pain. You will be given analgesia (painkillers) through the drip or via an epidural (into your back).

How long will I stay in hospital after major bowel surgery?

Following major bowel surgery, you should expect to be in hospital for seven to ten days. The actual time will depend on how you have progressed. Before you leave hospital, you must be eating and drinking, and your bowels must be working.

How long will it take for me to recover from the operation?

For most people (whatever their age), it can take up to three months to recover from major bowel surgery. During the first three to four weeks at home, you will feel tired and weak. It is important that you take a reasonable amount of rest. However, it is not good for you to stay in bed all of the time. You should try to take some gentle exercise such as walking around the house or garden. If you live alone (and have no friends or family to help you), please let us know, and we will try to organise some help or convalescence for you.

When can I return to work after major bowel surgery?

If you have a very active job (especially if it requires lifting), you are likely to need eight weeks off work. If you have a less strenuous job (such as working in an office), you may go back earlier. You will not do yourself any harm by returning to work; so, if you feel able to work, do so, but be prepared perhaps to start off by working part time.

What precautions should I take after major bowel surgery?

For the first six weeks, you are advised not to lift anything heavy (such as shopping or wet washing) and not to do anything strenuous (such as digging the garden or mowing the lawn). You should not drive until you feel safe and confident that you can do an emergency stop without the hesitation that you might get for fear that your wound will hurt.

Will the surgery affect my appetite?

After the surgery, it will be some time before your appetite gets back to normal. Try eating 'little and often' to begin with; as the days pass, you will gradually feel stronger and able to do a little more each day.

What follow-up will I need?

After major bowel surgery, an outpatient appointment (for approximately six weeks) will be sent to you in the post. Some patients who have surgery for bowel cancer can benefit from additional treatment (called adjuvant therapy) in the form of chemotherapy or radiotherapy and, therefore, might receive an appointment to see the oncologists (who treat patients with cancer).

After major bowel surgery, you may resume sexual intercourse when it is comfortable for you, which is often four to six weeks after the surgery. If their rectum has been removed, some women experience painful intercourse because of narrowing and shortening of the vagina; occasionally, this is accompanied by a loss of sensation or a reduction in vaginal secretions. Often, simple solutions can be found to these problems, and they will be discussed with you (and your partner if you wish). For men to be able to obtain an erection, they need to have an intact nerve and blood supply to the penis. During some types of bowel surgery (particularly those involving the rectum), the nerve and blood supply to the penis can be unavoidably damaged or disturbed, which can lead to impotence (inability to get an erection) or ejaculation problems. These problems can be temporary or permanent, and will be discussed with you, both before and after your surgery. If you are a man who is about to undergo such surgery and have not started or completed a family, we will discuss with you the possibility of ‘banking’ your sperm just in case you should experience sexual difficulties. If your surgery does result in you having sexual difficulties, we will talk to you about this (and your partner if you wish), and refer you to the appropriate specialist who might be able to help with the situation.